Small Animal ECC Flashcards
What should an initial triage include
brief history, quick PE, resuscitation status
What are the ABC’s of a primary survey
Airway, attitude
Breathing, bleeding
Cardiovascular, circulation
What should you always do if in doubt of patient respiratory status
start supplemental oxygen until further assessment can be completed
What is inspiratory dyspnea
long slow inspirations with short exhalations
What is usually the cause of inspiratory dyspnea
extrathoracic airway obstruction, such as larpar or swelling associated w/ an acute hypersensitivity reaction
What is expiratory dyspnea
increased abdominal effort on expiration
What causes expiratory dyspnea
intrathoracic obstruction, such as mass compressing the airway or inhaled foreign body
Labored breathing is
prolonged and deep
restrictive breathing is
fast, short, and shallow; (usually from impaired ability to expand the lungs like rib fractures, effusion, etc.)
Orthopnea is
maintaining a specific posture to ease breathing
orthopneic patients can become _ or _ if repositioned
distressed or aggressive
Decreased mentation can indicate
shock
Vitals of the cardiovascular system
Menatation
HR and rhythm
Pulse quality
Extremity temperature
MM color
CRT
Elevated _ levels can be extremely bad for a patient with increase intracranial pressure and traumatic brain injury
carbon dioxide
What is anisocoria
one big pupil and one little pupil
Signs of severe abdominal pain
arched back, praying posture
What is tympany
swelling of the abdomen with air or gas
What should be looked for upon quick abdominal palpation
pain, tympany, a fluid wave
Common causes of dehydration
v/d, excessive panting, PU, decreased water intake
Clinical signs of dehydration
tacky or dry MM
lack of skin turgor
mental status
body weight
Common laboratory abnormalities in dehydrated patients
-Hemoconcentration (abnormally high concentration of blood)
-Azotemia (too much nitrogen, creatinine, and other waste products in the blood)
-Hypernatremia (a rise in serum sodium concentration due to net water loss or excess sodium intake)
-Elevated albumin
Hypovolemia is
a loss of intravascular volume
Hypovolemia commonly occurs with
shock, trauma, hemorrhage or profuse v/d
vitals of hypovolemic shock
tachycardia
weak pulses
hypotension
prolonged CRT
What is needs to be done immediately for a hypovolemic patient
restore blood volume quickly
High-yield diagnostics that determine overall patient stability
PCV
TP
BG
Blood gas analysis
BP
Pulse ox
ECG
FAST scan
What should be provided throughout the initial stabilization, diagnostics, and secondary tx phases
fluid therapy
Shock is a complex syndrome resulting from
altered blood flow or impaired delivery of oxygen to tissues
What does early stages of shock look like
-Depressed or anxious
-Tachycardic and tachypneic
-Normal, decreased, or increased pulse
Terminal stage of shock looks like
Massive vasodilation, hypotension, cardiac arrest
What type of shock is described?
-Most common type in cats and dogs
-Trauma, hemorrhage, severe v/d
-Decreased intravascular fluid volume
-Delayed CRT, weak pulse, pale mm, altered mentation
-Tx: restore intravascular volume (IV fluids +/- transfusion)
Hypovolemic shock
What type of shock is described?
-Maldistribution of blood flow, from inappropriate vasodilation leading to pooling of blood in capillaries
-Anaphylaxis, heat stroke, and envenomation
-Weak or bounding pulse, pink mm
-Tx: fluid therapy, vasopressors
Distributive shock
What type of shock is described?
-Venous return to heart is impaired
-GDV or pericardial tamponade (collapse of right atrium)
-Tx: tx underlying cause
Obstructive shock
What type of shock is described?
-Secondary to heart problems
-Weak pulse, hypotension, pale mm, +/- cold extremities, pulmonary edema, heart murmur
-Fluids are contraindicated!!!
-Tx: improve heart function; diuretics needed to resolve pulmonary edema
Cardiogenic shock
What type of shock is described?
-Severe infection insult (pneumonia, parvo, bowel perf. , bite wounds, etc.
-Can also occur as a sequela to severe tissue damage (ex: heat stroke, pancreatitis)
-Bright red mm, fever, and bounding pulse
-As it progresses, mm turn pale and weaker pulses
-Tx: tx source of infection, fluid therapy, and broad- spectrum antbx
Septic shock
Shock results in widespread _ _ and damage, and the inflammation can progress from local to systemic
tissue hypoxia
Systemic inflammatory response syndrome (SIRS) can lead to
Disseminated intravascular coagulation (DIC)- concurrent thrombosis and bleeding
Another complication of shock and sepsis is Multiple organ dysfunction syndrome (MODS), secondary to SIRS. This causes?
permanent organ failure and death
Prep for abdominocentesis
left lateral recumbency, aseptic prep, 20/22-g needle or catheter placed in the 4 quadrants around umbilicus
If abdominal fluid seems hemorrhagic, observe for _
clotting; if clot develops, this is fresh blood vs free fluid in the abdomen
Thoracic drain placement (AKA chest tube) may be necessary with large amounts of fluid or air and should be placed if:
more than 2 thoracocenteseses are needed within a few hours
Mechanical ventilation is a means of
long term intensive respiratory support to critically ill patients
Complications of mechanical ventilation
pressure ulcers
peripheral edema
edematous tongue
pneumonia
Cardiopulmonary arrest (CPA) is
cessation of spontaneous respirations and lack of perfusing heart rhythm
Some animals will have _ _ before a full CPA- timing is crucial for survival
respiratory arrest
Absence of _ is sufficient to start CPR
respiration
Advanced life support methods
medications
defibrillation
open-chest procedures
Delaying compressions is worse than
performing them on an animal not in CPA
how much breathes should you deliver to a patient during CPR and how often
10brpm; 1-second inspiration and 5-second expiration
How should CPR be performed on cats and small dogs <5-7kgs
lateral recumbency, one hadn’t circling the ventral chest, compressions performed directly over heart using whole hand
CPR for keel-chested dogs (greyhounds)
at 5th intercostal space with dog in lateral position
Round-chested cpr (chest w/ similar width and depth)
apply compressions to widest part of chest with dog in lateral
For quality chest compressions, you should compress the thoracic walk by
30-50%
CPR bpm for cats and dogs
100-12o bpm
As compressions restore perfusion, ETCO2 should rise and reach _mm Hg or higher
15
Check every - seconds for return of spontaneous circluation (ROSC)
10-15
What is open chest CPR
making an incision in the left 5th intercostal space, freeing the heart from its attachments, and directly massaging the heart from apex to base
If patient is still in CPA after the first cycle, _ +/- _ are often employed
medications; defibrillation
What is asystole
complete cessation of all mechanical and electrical activity in the heart
What is it called when the electrical system of the heart is functioning (as evidence by ECG) but no mechanical heartbeat occurs in response to electrical stimulation
PEA
V-fib is highly disorganized contractile activity of the heart, often preceded by a
rapid pulseless ventricular tachycardia
initial dose of defibrillation
4 joules per kg (.4J / kg with open chest paddles)
NAVEL stands for
Naloxone, atropine, vasopressin, epi, and lidocaine
Endotracheal tube drug doses are _times IV dose
2x
Up to _% undergo another CPA within 12 hours
82
overall survival rate for all causes of CPA is
4-9%
After successful CPR, tx should focus on
treating the underlying cause of CPA and treating the systemic effects of the CPA and resuscitation
_ may be needed in immediate post arrest period
Ventilation
How does hypoxia and hypotension effect GI tract
leads to breakdown of GI mucosal barrier, which can cause transiocation of bacteria into systemic circulation. Potential for sepsis
How to monitor kidneys post arrest
monitor fluid in and out to maintain fluid balance
Anoxic, hypoxic, and repercussion injury manifest as _ edema
cerebral
Furosemide should NOT be used with
hypovolemia
_ and _ are especially sensitive to alterations in BP
brain and kidneys
BP cuff width should be -% of the circumference of the limb at the site of cuff placement
30-50
Arterial BP: during each cardiac cycle, BP varies from a max (systolic pressure) and a minimum pressure (diastolic pressure). MAP is the average and should range from -
70-100mm Hg
Most common sites of catheterization of artery
dorsal metatarsal and femoral
Four basic features of ECG
HR, Heart rhythm, P-QRS-T waveforms and intervals, Mean electrical axis (MEA)
